title: Effect of the Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA) on malnutrition of infants in Rajasthan, India: a mixed methods study.
abstract: OBJECTIVE
  Analyse the effect of the Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA), a wage-for-employment policy of the Indian Government, on infant malnutrition and delineate the pathways through which MGNREGA affects infant malnutrition.
  
  
  OBJECTIVE
  MGNREGA could reduce infant malnutrition through positive effects on household food security and infant feeding.
  
  
  METHODS
  Mixed methods using cross-sectional study and focus group discussions conducted in Dungarpur district, Rajasthan, India.
  
  
  METHODS
  Infants aged 1 to <12 months and their mothers/caregivers. Final sample 528 households with 1056 participants, response rate 89.6%. Selected households were divided into MGNREGA-households and non-MGNREGA-households based on participation in MGNREGA between August-2010 and September-2011.
  
  
  RESULTS
  Infant malnutrition measured using anthropometric indicators - underweight, stunting, and wasting (WHO criteria).
  
  
  RESULTS
  We included 528 households with 1,056 participants. Out of 528, 281 households took part in MGNREGA between August'10, and September'11. Prevalence of wasting was 39%, stunting 24%, and underweight 50%. Households participating in MGNREGA were less likely to have wasted infants (OR 0·57, 95% CI 0·37-0·89, p = 0·014) and less likely to have underweight infants (OR 0·48, 95% CI 0·30-0·76, p = 0·002) than non-participating households. Stunting did not differ significantly between groups. We did 11 focus group discussions with 62 mothers. Although MGNREGA reduced starvation, it did not provide the desired benefits because of lower than standard wages and delayed payments. Results from path analysis did not support existence of an effect through household food security and infant feeding, but suggested a pathway of effect through low birth-weight.
  
  
  CONCLUSIONS
  Participation in MGNREGA was associated with reduced infant malnutrition possibly mediated indirectly via improved birth-weight rather than by improved infant feeding. Addressing factors such as lack of mothers' knowledge and inappropriate feeding practices, over and above the social and economic policies, is key in efforts to reduce infant malnutrition.
authors.affiliation: National Perinatal Epidemiology Unit (NPEU), Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
authors.forename: Manisha
authors.initials: M
authors.lastname: Nair
authors.forename: Proochista
authors.initials: P
authors.lastname: Ariana
authors.forename: Eric O
authors.initials: EO
authors.lastname: Ohuma
authors.forename: Ron
authors.initials: R
authors.lastname: Gray
authors.forename: Bianca
authors.initials: B
authors.lastname: De Stavola
authors.forename: Premila
authors.initials: P
authors.lastname: Webster
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D017144:Focus Groups; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D007228:Infant Nutrition Disorders / Q000453:epidemiology* / Q000517:prevention & control*; D008954:Models, Biological; D009035:Mothers; D009786:Occupational Health Services; D016017:Odds Ratio; D011640:Public Policy / Q000331:legislation & jurisprudence*; D012423:Rural Health